Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air in the pleural cavity caused by injury to parietal pleura/rupture of visceral pleura

Question 2

What is a small pneumothorax?

Answer 2

<2 cm gap between lung and parietal pleura

Question 3

What is a large pneumothorax?

Answer 3

> 2 cm gap between lung and parietal pleura

Question 4

What is a tension pneumothorax?

Answer 4

Torn pleura acts as a one-way valve
Air can get in each time but air can’t out on expiration
Pneumothorax expands and the lung collapses towards its route
Build-up of air apples tension to mediastinal structures causing mediastinal shift

Question 5

What are clinical features of pneumothorax?

Answer 5

Reduced chest expansion
Reduced breath sounds
Hypotension if SVC compressed
No lung markings on CXR

Question 6

What is the hallmark sign of a tension pneumothorax?

Answer 6

Tracheal deviation

Question 7

How do you treat a large pneumothorax?

Answer 7

Needle aspiration (thoracentesis) 
Chest drain (4th or 5th IC space mid-axillary)

Question 8

How do you treat a tension pneumothorax?

Answer 8

Large gauge (16G) cannula into 2nd or 3rd IC space midclavicular line

Question 9

How do you treat a small pneumothorax?

Answer 9

Some will resolve on their own - observe with CXRs